Drug Use, Sexual Activity, and Suicidal Behavior in U.S. High School Students

In 1990, suicide ranked as the fifth leading cause of potential life lost before age 65 in the United States.[1] The problem is particularly profound among young people with the incidence of suicide among adolescents and young adults nearly tripling in the past three decades.[2] In 1992, for example, suicide was the third leading cause of death among those ages 15-19 (10.9 per 100,000).[1] During 1993, approximately 30,000 suicides were reported in the United States,[3] with 250 occurring in persons younger than age 15 and 4,900 among persons ages 15-24. The actual number of suicides may be two to three times larger due to underreporting and the likelihood that a significant number of fatal motor vehicle accidents as well as homicides actually may be suicides.[4] For every completed suicide, an estimated 50 to 200 suicides are attempted but not completed. Approximately one-third of those attempting suicide will do so again within two years.[5] The increase in suicide rates among the young occurred despite the fact that the overall U.S. base rate for suicide remained relatively stable over the past 20 years. Recognizing these trends, the U.S. Public Health Service is committed to reduce suicides among youth ages 15-19 to no more than 8.2 per 100,000 and reduce the incidence of injurious suicide attempts among adolescents by 15% by the year 2000.[6]

Data from the 1990 Youth Risk Behavior Survey of U.S. high school students (grades 9-12) shows that 8.3% of respondents made at least one suicide attempt in the 12 months prior to the survey. A greater percentage of females than males reported making attempts (10.3% to 6.2%) and having an attempt result in the need for medical attention (2.5% to 1.6%). Based on these data, it can be estimated that 276,000 high school students made at least one suicide attempt requiring medical attention in the year preceding the survey.[7] The youth rate appears to have plateaued in the late 1980s and stabilized at the higher rates.[8]

A variety of reasons account for the increase in youth suicide: 1) an increase in the incidence and prevalence of psychiatric risk factors including depression, conduct disorders, and substance abuse, 2) a higher proportion of adolescents in the general population resulting in greater competition for economic and educational resources with greater potential for failure, and 3) an increase in violent behavior and access to firearms. More generally, increased divorce rates, changes in family structure, and geographic mobility all are likely contributors to the phenomenon.[9]

The school setting provides a potential opportunity for health educators to assist with suicide prevention. Although some educators support school-based intervention strategies, others question if school-wide education is an effective technique. Some researchers suggest school-wide exposure to suicidal behavior may serve as a catalyst for other suicides.[2] One key to the development of effective school-based prevention strategies may be targeting "at-risk" adolescents. Therefore, it is imperative that school personnel be aware of the potential risk factors for suicidal behavior.

To prevent suicide, factors that influence this behavior must be identified. The most commonly studied influences on suicidal behavior are psychosocial variables, interpersonal relationships, previous antisocial behaviors, suicide ideation, and previous suicide attempts. The most frequently discussed factor is depression. Other suicide risk factors include poor family and peer relationships, substance use, early sexual activity, suicide ideation, access to handguns, and previous suicide attempts.[10] Few studies have addressed the interrelationships among substance use, sexual activity, and suicide behavior. In addition, most data concerning adolescent suicide risk factors were obtained from small and convenient populations with limited minority representation.

Recent studies of adolescents being treated for substance abuse show they are at high risk for attempting suicide. …

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